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Testicular Torsion

In testicular torsion, there's twisting of the spermatic cord, and it is a urological emergency. Any delay in treatment increases the risk of ischaemia and necrosis, therefore leading to infertility/subfertility:

  • If surgery done < 6hrs, salvage rate = 90-100%

  • If surgery done > 24hrs, salvage rate = 0-10%


Differentials - Acute epididymitis, Epididymo-orchitis, Trauma, Tumour, Hydrocoele


Presentation

Typical presentation of sudden unilateral testicular pain that may be associated with abdominal pain and vomiting and is triggered by activity, such as sports (important to ask what the patient was doing when the pain started).


O/E:

  • Firm, swollen, warm testicle

  • Elevated/Retracted testicle that may lie horizontally

  • Absent cremasteric reflex

  • Negative Phren’s sign - This is what helps rule out an important differential of acute epididymitis as elevation of the testicle will relieve pain in acute epididymitis, but won’t in torsion.


Investigations

Immediate surgical exploration


Management

  • Analgesia

  • Orchiopexy - correcting position of testicle and fixing it into place

  • Orchidectomy - removal of testicle if surgery is delayed or testicle is necrotic



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